Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Ownership (CHOW) Contract Supplier Notification Form New 92 46 0 Form and Instruction CMS-10169
Change of Ownership (CHOW) Purchaser Form New 111 111 0 Form and Instruction CMS-10169
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Application for Suppliers (Form A) Removed 0 0 0 Form and Instruction CMS-10169
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Bidding Form (Form B) Removed 0 0 0 Form and Instruction CMS-10169
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C) Modified 4952 1651 0 Form and Instruction CMS-10169
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure Modified 390 160 0 Form and Instruction CMS-10169
Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D) Modified 14667 7333 0 Form and Instruction CMS-10169
Total burden requested under this ICR: 20212 9301 0  
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